Editor, We read with great interest the article published by Filippi et al. (1) regarding the usefulness of dopamine in the treatment of hypotension in preterm, very low birth weight (VLBW) infants. Recently Dempsey and Barrington (2) reported how there are marked variations between neonatologists in interventions and treatments for neonatal hypotension. In medical literature is well reported how dopamine should be considered the first choice to support neonates, even if the labelling information regarding the use of inotropes in this population is inadequate (3). It came to our attention the case of a VLBW infant hospitalized in our III level neonatal intensive care unit. After an uneventful bicorial and biamniotic pregnancy, the baby, first of two twins, was born by caesarean section at 32 weeks of gestation. Two hours after birth he developed hypotension (blood pressure 39/20 mm Hg; mean pressure 27 mm Hg) and we decided to give him a saline bolus of 10 cc/Kg in 20 minutes to maintain adequate tissue perfusion. Because of persistent hypotension, dopamine was added at 5 mcg/Kg/min via umbilical venous catheter. After three hours no ameliorations in his systolic pressure were noticed, although dopamine was increased at 8 mcg/Kg/min. Suddenly, he presented a cyanotic skin rash characterized by acromial ischemia. We decided to stop therapies, worried about an allergic reaction and hydrocortisone was given (1mg/Kg) in order to promote resolution. The rash and the acromial ischemia of right arm and left foot took few hours to resolve. Dopamine was not given again. Ischemia in our patient did not involve other organs, systolic pressure improved after this episode and no other inotrope had to be used. To our records, this is the first experience we had about dopamine sudden side effects, and surprisingly, even if this is mentioned in the drug label, we could not find any report in medical literature. References 1. Filippi L, Pezzati M, Poggi C, Rossi S, Cecchi A, Santoro C. Dopamine versus dobutamine in very low birthweight infants: Endocrine effects. Arch Dis Child Fetal Neonatal Ed 2007; 92 (5): F367-F371. 2. Dempsey EM, Barrington KJ. Treating hypotension in the preterm infant: when and with what: a critical and systematic review. J Perinatol 2007; 27 (8): 469-78. 3. Evans JR, Short BL, Van Meurs K and Sachs HC. Cardiovascular support in preterm infants. Clin Ther 2006; 28 (9): 1366-1384.